title: Use of Web-based training for quality improvement between a field immunohistochemistry laboratory in Nigeria and its United States-based partner institution.
abstract: The importance of hormone receptor status in assigning treatment and the potential use of human epidermal growth factor receptor 2 (HER2)-targeted therapy have made it beneficial for laboratories to improve detection techniques. Because interlaboratory variability in immunohistochemistry (IHC) tests may also affect studies of breast cancer subtypes in different countries, we undertook a Web-based quality improvement training and a comparative study of accuracy of immunohistochemical tests of breast cancer biomarkers between a well-established laboratory in the United States (University of Chicago) and a field laboratory in Ibadan, Nigeria. Two hundred and thirty-two breast tumor blocks were evaluated for estrogen receptors (ERs), progesterone receptors (PRs), and HER2 status at both laboratories using tissue microarray technique. Initially, concordance analysis revealed κ scores of 0.42 (moderate agreement) for ER, 0.41 (moderate agreement) for PR, and 0.39 (fair agreement) for HER2 between the 2 laboratories. Antigen retrieval techniques and scoring methods were identified as important reasons for discrepancy. Web-based conferences using Web conferencing tools such as Skype and WebEx were then held periodically to discuss IHC staining protocols and standard scoring systems and to resolve discrepant cases. After quality assurance and training, the agreement improved to 0.64 (substantial agreement) for ER, 0.60 (moderate agreement) for PR, and 0.75 (substantial agreement) for HER2. We found Web-based conferences and digital microscopy useful and cost-effective tools for quality assurance of IHC, consultation, and collaboration between distant laboratories. Quality improvement exercises in testing of tumor biomarkers will reduce misclassification in epidemiologic studies of breast cancer subtypes and provide much needed capacity building in resource-poor countries.
authors.affiliation: Department of Pathology, University College Hospital, Ibadan, Nigeria. Electronic address: oluwasola7@gmail.com.
authors.forename: Abideen O
authors.initials: AO
authors.lastname: Oluwasola
authors.forename: David
authors.initials: D
authors.lastname: Malaka
authors.forename: Andrey Ilyich
authors.initials: AI
authors.lastname: Khramtsov
authors.forename: Offiong Francis
authors.initials: OF
authors.lastname: Ikpatt
authors.forename: Abayomi
authors.initials: A
authors.lastname: Odetunde
authors.forename: Oyinlolu Olorunsogo
authors.initials: OO
authors.lastname: Adeyanju
authors.forename: Walmy Elisabeth
authors.initials: WE
authors.lastname: Sveen
authors.forename: Adeyinka Gloria
authors.initials: AG
authors.lastname: Falusi
authors.forename: Dezheng
authors.initials: D
authors.lastname: Huo
authors.forename: Olufunmilayo Ibironke
authors.initials: OI
authors.lastname: Olopade
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D001943:Breast Neoplasms / Q000145:classification / Q000378:metabolism / Q000473:pathology*; D003194:Computer-Assisted Instruction / Q000379:methods*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D020407:Internet; D007753:Laboratories / Q000592:standards; D008875:Middle Aged; D009549:Nigeria; D015588:Observer Variation; D010336:Pathology / Q000193:education* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000706:statistics & numerical data*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012107:Research Design / Q000592:standards; D046888:Tissue Array Analysis; D014481:United States
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: Immunohistochemistry; Quality improvement; Tissue microarray; Web-based conferences